Citing inaccurate science, a leading Colorado lawmaker is signaling he'll oppose providing funds for a state program that, during a five-year privately-supported test phase, reduced teen pregnancies by 40 percent.

A state program in Colorado that’s reduced teen pregnancies by 40 percent over five years and teen abortions by 35 percent is facing opposition from a Republican state lawmaker who is wrongly concerned that intrauterine devices (IUDs), distributed for low or no cost as part of the program, cause abortions.

Private funding for the state-run Colorado Family Planning Initiative ends this year, and state Rep. KC Becker (D-Boulder) is working on a bill providing $5 million to keep the program going.

Becker’s bill is opposed by state Sen. Kevin Lundberg (R-Berthoud), who told the Ft. Collins Coloradoan that the Colorado Department of Public Health and Environment’s arguments for the bill amounted to “poor science,” citing his belief that IUDs work by “stopping a small child from implanting.”

“Protecting life is a very big issue,” the Coloradoan also quoted Lundberg as saying. “In my mind, that’s what government is all about, and to protect the life of the most vulnerable and most innocent seems to be the most important.”

Under the Family Planning Initiative, about 30,000 IUDs and other long-lasting contraceptive implants were distributed during a five-year pilot program. Participating clinics in 37 of Colorado’s 64 counties serve 95 percent of the state’s population.

The initiative saved $23 million in Medicaid costs since it started five years ago, and continuing the family planning initiative will save $40 million in Medicaid funds, the Department of Public Health and Environment has estimated.

Republicans hold a one-seat majority in Colorado’s senate, but observers say the teen pregnancy program funds may still clear the chamber, even without the support of Lundberg, who chairs the Health and Human Services Committee. Becker, the state house sponsor, has said her bill has a Republican co-sponsor, who has yet to be named.

Becker told the Coloradoan that she is currently trying to dispel the myth that IUDs cause abortions.

But high-ranking Republicans in Colorado, including 2014 GOP gubernatorial candidate Bob Beauprez, who lost to pro-choice Gov. John Hickenlooper in November, think otherwise.

Because Depo-Provera is an important contraceptive choice and because in many parts of the world, it is the only long-acting, discreet option available to women, it is vital to take the issue of a link between HIV and hormonal contraception quite seriously while adding nuance to the discussion.

A newly published study by Lauren Ralph et al and an accompanying commentary in the journal Lancet Infectious Diseases is stirring up questions about the relationship between Depo-Provera, and other progestogen-only injectable contraceptives, and the risk of HIV acquisition among HIV-negative women. Based on a meta-analysis of previously published studies, the report’s authors determined that Depo use is associated with a “moderate risk” of HIV infection.

The study triggered a wave of headlines and tweets that boiled down the complexities and caveats of this analysis into an oversimplified statement: Depo increases women’s risk of HIV by 40 percent. Because Depo is an important contraceptive choice—it provides protection against unwanted pregnancy for three months after a single shot—and because in many parts of the world, it is the only long-acting, discreet option available to women, it is vital to add nuance to these headlines, while also taking the issue of a link between HIV and hormonal contraception quite seriously.

The first, and arguably most crucial, thing to understand about this new paper is that it is not based on new data, or raw information. It is simply a new analysis of a set of observational studies of rates of HIV in women using different contraceptive methods. Previous systematic analyses have included all but one of these studies; last week’s paper simply crunched those numbers, so to speak, in a new way.

About that number-crunching: Ralph’s paper concludes that those previously published studies, when analyzed as a group, suggest that there is an overall increase in risk of about 40 percent of contracting HIV associated with using Depo. The increased risk is greatest in women at “high risk” of HIV infection, which the authors define as HIV-negative women who engage in commercial sex work and/or those with known regular HIV-positive partners (women in what are known as “serodiscordant couples”). When these “high-risk” women were excluded from this meta-analysis, there was a 30 percent increase risk associated with Depo use. The study authors described this analysis as the risk for women in the “general population.”

The question of whether hormonal contraception of any kind—pills, injectables, and implants—increase HIV risk has concerned sexual and reproductive health advocates—who among other things want to simultaneously prevent HIV and ensure people can plan pregnancies—for many years. Previously published systematic reviews of observational data have examined the results from many studies and haven’t settled the question. The Ralph paper is the latest addition to this body of literature.

Like all the previous analyses, Ralph’s paper worked with existing observational data, which was gathered from studies that were either not designed to specifically address the hormonal contraception-HIV link or did not randomly assign women to use a specific method. Observational data of this kind has inherent biases—for example, women who choose a specific contraceptive method might also have other attributes that affect their HIV risk. Observational studies can try to identify factors like these, but it’s not possible to account for everything that might be in play. So although a paper like the Ralph study might be giving what looks like a precise estimate of risk associated with Depo use, it’s on the basis of studies that, by definition, lack a high degree of precision.

Previous analyses have looked at all but one of the studies included in the Ralph paper. These earlier analyses were “systematic reviews” that sifted through available studies, selected ones with high-quality evidence and analyzed the findings. The bottom line from this approach: Some observational studies did show an increased risk linked with Depo use, and others did not. In fact, the conclusions from the most recent systematic review emphasized the ongoing uncertainty around the subject and the need for all women, including those using Depo and other injectables, to be counseled and empowered to access and use male and female condoms and other HIV prevention tools.

Those systematic reviews did not perform statistical analyses that pooled all of the results of the different studies to come up with a single numerical estimate of risk. The Ralph paper did—and this is what makes it both new and particularly prone to alarmist headlines.

The authors argue that the 40 percent estimate of increased risk linked to Depo use should be used to guide more precise models of the impact of Depo on HIV infections in different settings. These models calculate the relative contribution to new HIV infections given different theoretical estimates of the risk associated with Depo use. Such models have been developed to show how much of an impact Depo would have to have on HIV risk to make the number of new infections outweigh the risk of unplanned pregnancy for women. Here, too, it’s important to understand the scenarios in question. Some of the models suggest that the choice is Depo or nothing—which is not necessarily a realistic assessment.

The authors pick up on this theme, arguing that the moderate risk associated with Depo use should be weighed against the risks of maternal morbidity and mortality if Depo is “banned.” This is a misleading analysis: In the many discussions at the World Health Organization, country, and community level that have taken place in the past few years on this issue, there is no scenario or proposal in which Depo would be banned or even removed from programs without provision of a comparable alternative.

Instead, the relevant proposals and programs—as exemplified by South Africa’s new contraceptive policy—seek to expand “method mix” (the range of options women can choose from). Specifically, the proposals and programs identified by advocates, funders, and many other stakeholders focus on expanding the use of other long-acting, discreet methods such as implants and the intrauterine device (IUD) that could be used instead of Depo by women making informed choices based on what is known and unknown about all the options available.

That said, having a more precise estimate to use in models can help policymakers, communicators, advocates, and program implementers have more informed conversations about what to do given the current uncertainty. It’s also really important to remember that all of the models conclude that the question of whether Depo increases risk is of greatest relevance in East and Southern Africa, where injectable contraceptive use—Depo is often one of a very limited number of contraceptive options available—and HIV rates are both high.

Every time a new study about Depo and other hormonal contraception and HIV comes out, women ask their peers, the Internet, or the Twitterverse, what it means for them. The meta-analysis isn’t designed to provide guidance for individuals per se, and the authors steer clear of it. So we’re left with existing guidance and precedent to help make practical suggestions. A few things stand out: For the individual Depo user, the reality is that there is uncertainty about how this contraceptive method affects her risk of HIV. But there are data that suggest that Depo use might increase risk of HIV acquisition. Women who don’t know their partners’ status, or do know that they have an HIV-positive partner, or who have many partners and are concerned about HIV, should be using condoms, and this has always been the case. Women using Depo who fall into these categories can consider switching contraceptive methods if there is another one that is available that meets their needs—but it is an individual choice, and there is no normative guidance (such as from the WHO) that says what the best alternative option is.

In addition, one interpretation of the study’s results is that there is an urgent need for a trial that would use a randomized design to directly measure HIV rates of women using three different methods: Depo, the Jadelle implant, and the copper IUD. This type of trial design would eliminate many of the biases associated with observational data and could provide much-needed clarity on the issue. It would also gather data on newer methods, such as the implant, which also contain hormones. Right now, there’s no information on the implant and HIV risk.

As the study authors and the authors of the commentary acknowledge, there has been a lot of debate and discussion about such a trial. AVAC has worked in coalition with ICW East Africa, the ATHENA Network, and many other women’s organizations to articulate the urgent need for clarity on the relationship between HIV risk and Depo, and other hormonal contraceptive methods. We have articulated the need for a trial that provides clarity and shifts policy.

But this is one viewpoint. There is a robust civil society constituency following the issues around hormonal contraception and HIV. Members of this dialogue have diverse views on whether a randomized trial is the correct path. This study is a potent reminder that this issue needs all hands on deck to clarify what is known and unknown, and to help articulate that the way forward doesn’t hinge on one number, one trial, or one opinion. HIV programming and family planning must address the uncertainty with clear messages on the risks and benefits of all methods; invest in increased method mix today; and sustain investment in developing new contraceptive, HIV prevention and, especially, multi-purpose prevention options that could, in the future, reduce HIV risk and prevent unwanted pregnancies. It is a multi-faceted approach to match the multi-faceted reality of women’s health needs—that may not fit in a headline, but it’s the honest truth and an urgent priority.

Intrauterine devices were popular until the '70s, when one model caused infertility and even death in some women. Though the new generation of IUDs are safe and effective, it has been a slow climb back to their previous rates of acceptance.

New data, released last week as part of the National Survey of Family Growth, finds that 6.4 percent of women ages 15-to-44 are currently relying on intrauterine devices (IUDs) as a method of contraception. While this lags behind those who are using the pill (16 percent) and even sterilization (15.5 percent), it shows a renewed interest and increased trust in a highly effective birth control method that had fallen out of favor. This is good news for public health advocates—many of whom believe that long-acting methods like the IUD are the key to preventing unintended pregnancy in this country.

Today’s IUDs are small t-shaped plastic devices that are inserted into the uterus by a health-care provider. A string hangs down through the cervix to allow for removal. IUDs prevent pregnancy primarily by interfering with the path of the sperm toward the egg. Two of the IUDs on the market—Mirena and Skyla—also release hormones similar to those in some birth control pills, which thickens the cervical mucus (creating a barrier to sperm) and may also prevent ovulation. The other, called ParaGard, releases copper, which is thought to create a substance that is toxic to sperm. ParaGard lasts for ten years, Mirena for five, and Skyla for three, but any of them can be removed if a women wishes to become pregnant.

IUDs, which were first invented in the early 1900s, were at one point a very popular method of contraception. In the 1970s, there were 17 models of IUDs on the market manufactured by 15 different companies.

Unfortunately, one model, the Dalkon Shield, had severe design flaws. It has been described as looking like the shell of a horseshoe crab, but instead of having one large spike at the top, it had five short ones coming off of each side. These spikes were meant to keep the IUD in place, but they turned out to be very irritating to the lining of the uterus and could become embedded in the endometrium. The string on the device also differed from that on other IUDs and allowed bacteria to travel up it, into the uterus. Many users got pelvic inflammatory disease (PID), which in turn caused them to become infertile. In addition, the Dalkon Shield had a higher failure rate than other IUDs, and some users became pregnant. Those who did were at risk of septic miscarriage, a miscarriage followed by a severe infection. Eighteen women who used the Dalkon Shield died from this.

In 1974, the company A.H. Robbins took the Dalkon Shield off the market, but stories of complications and negative press continued, and more than 400,000 lawsuits were filed. Ultimately, A.H. Robbins went bankrupt and a $3 billion fund was set up to compensate women who’d had issues with the IUD.

Though only the Dalkon Shield was implicated in these medical issues, there was an impact on usage of all IUDs. “The Dalkon Shield single-handedly turned an entire generation of American women against all IUDs,” Jenny Higgins, a researcher at the University of Wisconsin who focuses on contraceptive usage, told RH Reality Check. “The same isn’t true in other countries, like France, where IUD use remained high. It’s understandable that women in this country lost faith in IUDs, but it’s too bad that they also lost out on a method that is not only highly effective but that many women really like.”

By 1986, there was only one IUD on the market, and few women were using it.

The new generation of the IUD was born a few years later with the introduction of ParaGard in 1988 and Mirena in 2000. Originally, these methods were approved only for use in women who had already had children, but as research showed their safety and efficacy, they were approved for use in all women. (The newest model, called Skyla, which was released in 2013, was designed for and is being marketed toward younger women who have not yet had children.)

Still, few women were using them until recently. A National Survey of Family Growth analysis found a steady downward trend in the percentage of women who had ever used an IUD, from 18 percent in 1982, to 10 percent in 1995, to 5.8 percent in 2002.

In the last few years, however, there has been a push by public health advocates and providers who would like to see more women, especially adolescents and young women, using this method. In 2011, the American Congress of Obstetricians and Gynecologists revised its official practice guidelines to suggest that young women could be offered IUDs. In 2012, it made this language stronger by saying that sexually active young women should be encouraged to use long-acting methods such as IUDs or contraceptive implants. The American Academy of Pediatrics announced in October of this year that it agrees that IUDs and implants should be considered a first-line contraceptive method for sexually active young women.

A number of interventions have found that increased IUD use does reduce the rates of unintended pregnancies. For instance, the CHOICE Project at Washington University in St. Louis, Missouri, which has provided contraception to over 9,200 women, found that after one year those who chose the pill, ring, or patch were 20 times more likely to have had an unintended pregnancy than those who chose the IUD or contraceptive implant.

What sets the IUD and implant apart from other methods is that user error is essentially taken out of the equation—a pill user can skip a dose, and a condom user can leave the protection at home, but once an IUD is put in place it works for between three and ten years without any further effort on the part of the user. This means that the efficacy rates in real life are just as good as the efficacy rates in a laboratory setting. In fact, IUDs have a failure rate of just 0.8 percent, which means that out of 100 couples who rely on this method each year, fewer than one will experience an unintended pregnancy.

The publicity IUDs have gotten as an effective birth control method may finally be enough to get rid of the stigma that’s been attached to IUDs since the Dalkon Shield. And indeed use is going up. The latest National Survey of Family Growth data suggests that 6.4 percent of women are currently using an IUD, compared to 5.6 percent between 2006 and 2010. Even more striking: In 1995, just 0.8 percent of women were using an IUD.

“It’s exciting to see this change because we are likely to see fewer unintended pregnancies among people who switch to IUDs,” said the University of Wisconsin’s Higgins. She pointed out, however, that the IUD is still used by far fewer women than hormonal birth control methods. She added that women who use IUDs have higher satisfaction and continuation rates than those who use other methods. “One of the reasons they’re so acceptable is the forgettable nature. You never have to think about this device that protects you from pregnancy,” she said. “The IUD may not be the best method for every woman, but it is great that it is once again being seen as part of our method mix.”

]]>http://rhrealitycheck.org/article/2014/12/18/iud-comeback-continues-apace/feed/7This Year in Sex: We’re Living in the Futurehttp://rhrealitycheck.org/article/2014/12/17/year-sex-living-future/?utm_source=rss&utm_medium=rss&utm_campaign=year-sex-living-future
http://rhrealitycheck.org/article/2014/12/17/year-sex-living-future/#commentsWed, 17 Dec 2014 14:43:57 +0000http://rhrealitycheck.org/?p=51135

Between the high-tech sex toys, transplanted uteri, lab-grown penises, and perils of hookup apps, 2014 sometimes sounded like a science fiction novel. But we can't forget the news about IUDs and STIs that came out this year, either.

This Year in Sex takes a look back at the news and research related to sexual behavior, sexuality education, contraception, sexually transmitted infections, and other topics that captured our attention in 2014.

The HPV Vaccine Works, It Doesn’t Cause Promiscuity, and There’s an Even Better One Coming

HPV and its vaccine made headlines many times this year. The upsetting news is that two new studies came out suggesting that we had been underestimating the number of both HPV cases and cervical cancer, but as far as the vaccine itself was concerned, things were looking pretty good.

First, and most importantly, it appears to be working. A 2013 study found that despite the fact that only half of teen girls had gotten one dose of the vaccine—and fewer than a third had gotten the recommended three doses—the proportion of teen girls infected with the HPV strains that the vaccine addresses has dropped by 56 percent. This year, another study confirmed this success when it found that states with high rates of HPV vaccines have lower rates of cervical cancer, and vice versa.

Additional research this year should (though probably won’t) also put to rest the idea that giving young people the HPV vaccine encourages them to engage in sexual behavior. One study found that young women do not change their attitudes or behaviors toward safer sex if they get the shot, and the other showed that girls with the vaccine are no more likely to get pregnant or be tested positive for a sexually transmitted infection than their unvaccinated peers.

More good news: Last week, the Food and Drug Administration (FDA) approved a new version of Gardasil, one of the two HPV vaccines on the market, which will protect against more strains of the virus. The original vaccine protected against strains 11 and 6, which cause most genital warts, and strains 16 and 18, which cause 70 percent of cervical cancer. The new vaccine, called Gardasil 9, will protect against these four strains in addition to five more cancer-causing strains—31, 33, 45, 52, and 58. Public health experts are hopeful that this added defense can prevent 90 percent of cervical, vulvar, vaginal, and anal cancers.

Wins and Losses for Those Who Want Condoms in Porn

Last year ended with a shutdown of filming—the third of its kind in 2013—in the porn industry after another actor was found to be HIV-positive. So it should be no surprise that this year included numerous rounds in the battle between producers who say no one wants to see condoms on film and public health experts who insist safer sex should start on set.

An effort to get California to pass a statewide law mandating condom use ultimately failed after facing a lot of opposition from porn company representatives, who threatened to take their business to a friendlier state, and porn stars who said it would force their industry underground and make their work more dangerous.

Defenders of the ban, however, did get an end-of-year victory this week when Measure B—a Los Angeles County ordinance requiring condoms on adult industry sets—was upheld by the Ninth Circuit Court of Appeals. A lower court had formerly upheld the measure, though it has yet to be systematically enforced.

The IUD Gains Supporters and Users

The intrauterine device (IUD) was once one of the more popular methods of birth control available. Then one model, the Dalkon Shield, came on the market with numerous design flaws that caused many users to become infertile, even resulting in several deaths. Though the dangers were unique to Dalkon Shield, women and physicians became suspicious of all IUDs; for many years, very few women—and only those who had already had children—would use them for contraception. In the last few years, however, IUDs have started getting more attention as providers and public health experts note the safety of newer models and the unparalleled efficacy rates.

This year, the IUD gained even more supporters, such as the American Academy of Pediatrics, which came out with a recommendation in October suggesting that IUDs be considered a first-line contraception for sexually active young people. Three months prior, research out of Colorado suggested that increasing the number of young women at Title X clinics using long-acting reversible contraceptives (which include both IUDs and implants) had led to lower than expected fertility rates among low-income women ages 15-to-24 in the state.

Other states, even conservative ones, decided this year that fixing the way Medicaid pays for IUDs—to make it possible to obtain one in a single visit, or even while still in the hospital after delivering a baby—could help prevent unintended pregnancies.

All of this support seems to be translating into increased use of the method. The National Survey of Family Growth found that 6.4 percent of contraceptive users were using an IUD in 2011-2013, compared to just 3.5 percent in the 2006-2010 survey.

Lab-Grown Penises and Transplanted Uteri

The future of reproductive health may include penises grown in a lab and babies born from transplanted uteri.

This year, the first baby to grow in a transplanted uterus was born to a 36-year-old Swedish woman whose name is being withheld. The woman, like the nine others who began the trial, had functioning fallopian tubes but was born without a uterus. After she received a donor organ from a friend of the family, doctors put her on anti-rejection drugs immediately. She became pregnant using IVF and had a relatively uncomplicated pregnancy, though the baby was delivered at 32 weeks when she showed signs of preeclampsia.

The medical team who undertook the trial hailed this as great news for assisted reproductive technologies, but others have expressed worry that the procedure is too invasive for both the donor and the recipient. Two of the nine women in the original study had to have their donor uteruses removed.

Meanwhile, no one has yet to be given a lab-grown penis, but new research on rabbits publicized in October suggests that it’s just a few years off. The process starts with a donor organ that is first stripped of its cells, then seeded with two different types from the genitals of the intended recipient. By making the penis out of the recipient’s own cells, scientist say they are reducing the chance of organ rejection. The procedure was tested on 12 rabbits; all successfully tried to mate using their engineered penis, eight were able to ejaculate, and four impregnated their bunny partner.

Truvada Dominates HIV-Prevention Discussion

Truvada is a combination of two antiretroviral drug used to treat individuals who have HIV. When used daily in HIV-negative individuals, these drugs have been shown to prevent transmission of the virus. The FDA approved the use of Truvada as a form of pre-exposure prophylaxis (PREP) in 2011 and it has been gaining popularity ever since.

This year, both the Centers for Disease Control and Prevention and the World Health Organization released guidelines suggesting that those at high risk of HIV infection—including injection users and men who have sex with men who are not in a monogamous relationship—consider using Truvada.

The method is highly effective. Studies have found that men who take it every day can reduce their risk of HIV infection by as much as 92 percent.

Still, some HIV advocates are concerned that those who choose Truvada—which can cost as much as $10,000 a year and needs to be taken every day—will stop using condoms, putting themselves and their partners at increased risk of other STIs, such as gonorrhea or syphilis.

The Dangers of Mixing Sex and Technology

The intersection between technology and sex got a little tricky this year as officials pointed to a dating app, Grindr, as being at least partially responsible for a syphilis outbreak; meanwhile, a jury in California found that an STI dating site called PositiveSingles had been sharing private information.

Grindr uses global positioning technology to help users meet other users nearby who are interested in getting together, presumably for sex. Grindr is marketed to men who have sex with men, but similar apps exist for heterosexual couples and women who have sex with women. This March, the popular app was at the center of an outbreak of syphilis in Onondaga County, New York.

A few months later, research in Los Angeles found that men who have sex with men who met partners on apps like Grindr had a 25 percent greater incidence of chlamydia and a 37 percent greater incidence of gonorrhea than those who met men in person at a bar, club, gym, private sex party, or even an online dating site. There was no difference in HIV rates or syphilis rates based on where men met.

The online dating sites, however, might pose another problem, at least according to a California jury that awarded 16.5 million dollars last month to a man who says the dating website PositiveSingles—which advertises itself as a place where people can meet other people living with STIs—violated consumer law and committed fraud by sharing information among many other niche websites owned by the same company. As the plaintiff’s attorney put it: “[my client] is not Black, gay, Christian or HIV positive and was unaware that [the] defendant was creating websites that focused on such traits that would include his profile, thus indicating that he was all of these things and more.”

Always a New Sex Toy

Finally, lest anyone worry that we will get bored heading into the new year, we take a look at the sex toys that emerged in the public eye in 2014. There’s the Svakom Gaga, a new vibrator introduced by a Chinese company that comes equipped with a camera and a USB port—plug it into your computer and star in your very own vulva video.

Of course, if you’re not ready for your close-up or you live far from your partner, you could instead turned to the OhMiBod, a vibrator that can be controlled from an iPhone via Bluetooth.

And, for the fitness buffs who aren’t satisfied knowing that they took their 10,000 steps a day, there is the kGoal, a U-shaped device that counts kegels. Women put one side of the device inside their vagina and the hook the other to their phones and are able to know exactly how many times they squeezed their pelvic floor muscles. Known as kegels, these exercises have been shown to help during childbirth, prevent or control urinary incontinence, and improve orgasms.

A number of states are working to improve access to long-acting contraceptive methods such as intrauterine devices (IUDs) and implants for Medicaid patients at the urging of the federal government’s Centers for Medicare and Medicaid Services (CMMS).

Illinois and New York this summer joined a host of other states—from Louisiana to Texas—that are trying to help women prevent unintended pregnancies and save state money at the same time.

Long-acting reversible contraceptives (LARCs) have gotten a lot of attention in recent years because they are highly effective in preventing unintended pregnancy, safe for women of all ages, and last between three and ten years.

In fact, in 2012 the American Congress of Obstetricians and Gynecologists released an opinion saying that IUDs and implants should be among the first contraceptive options suggested to women, even adolescent women. “When choosing contraceptive methods, adolescents should be encouraged to consider LARC methods,” the opinion says. “Intrauterine devices and the contraceptive implant are the best reversible methods for preventing unintended pregnancy, rapid repeat pregnancy, and abortion in young women.”

The American Academy of Pediatrics also suggested IUDs and implants as first-line contraceptive methods for sexually active teens, as RH Reality Checkreported, just this week.

Recent research has shown that when given information about and free access to LARCs, women opt for these methods and are satisfied with them.

The CHOICE Project at Washington University in St. Louis, Missouri, for example, began recruiting women ages 14 to 45 in 2007, and by September 2011 had closed the study having enrolled 9,256 women.

Women enrolled in the study received contraceptive counseling to help them choose a method and three years of contraceptive services for free. In a preliminary study of 5,086 participants, 70 percent chose a LARC method. Of those, 47 percent chose Mirena (a hormonal IUD), 11 percent selected ParaGard (the copper IUD), and 12 percent chose Implanon (the contraceptive implant).

Researchers followed participants and found that satisfaction and continuation rates among LARC users were higher than those of women using other methods. At 24 months, 77 percent of women who had chosen a LARC method were still using it, compared with 43 percent of those using the oral contraceptive pill, 40 percent of those using the contraceptive patch, 41 percent of those using the contraceptive ring, and 38 percent using the contraceptive shot. Continuation rates were higher for IUDs than implants.

Researchers concluded that participants who chose a LARC method at enrollment were at significantly lower risk of contraceptive method discontinuation compared with women who selected a non-LARC method. Not surprisingly, they were also at less risk of unintended pregnancy.

At the one year mark, pill, ring, and patch users were 20 times more likely to have had unintended pregnancy than LARC users.

Another intervention, the Colorado Family Planning Initiative (CFPI), sought to increase access to LARC methods by correcting misinformation, training providers, and providing these methods. This project worked with low-income women seeking services at Title X-funded clinics. CFPI began in 2009 and research found that by 2011, LARC use among women 15 to 24 had grown from 5 percent to 19 percent. By that point, one in 15 young, low-income women had received a LARC method, up from one in 170 in 2008.

The CFPI study also found that in 2011, the fertility rates among low-income women ages 15 to 19 were 29 percent lower than expected, and the rates among low-income women ages 20 to 24 were 14 percent lower.

Moreover, in those counties with a CFPI provider, abortion rates among women ages 15 to 19 fell 34 percent between 2009 and 2011, and rates for women ages 20 to 23 declined 18 percent. There was a 23 percent decline in infant enrollment in the federal WIC program (the Special Supplemental Nutrition Program for Women, Infants and Children) between 2010 and 2013.

While these results show how well LARCs can work in preventing unintended pregnancy and abortion, and helping women plan their families, LARCs remain underutilized by women across the country. Only 9 percent of contraceptive users are currently relying on these methods, according to the National Survey of Family Growth.

One of the barriers to use is the high upfront cost. An IUD can cost as much as $1,000, which includes the price of the device and the provider’s fee for insertion. When looked at over the long term, these methods are cost-effective—a woman who uses ParaGard for its full ten-year lifespan, for example, could pay as little as $4 a day—but with the whole fee due upfront, many women cannot afford it.

Though Medicaid pays for contraceptives, the reimbursement rules in many states make it difficult for participants to access IUDs and implants. The reimbursement rate in many states is less than the cost of the device, which means that providers lose money every time they do an insertion. Because the device itself is so expensive ($600 to $800) most providers do not keep it in stock in their offices.

Instead, they order it for an individual patient after she expresses interest. This means that women need to come to the office at least twice to receive the device. In some states the ordering process works like a prescription—once it is assigned to a patient, the device cannot be used on anyone else—if the woman does not come back for insertion, it gets thrown away.

This is one of the issues that states are addressing to make LARCs more affordable.

In Texas, Medicaid providers can order the devices from one of three pharmacies without any upfront costs. In South Carolina, one of the first states to expand LARC use, providers can get a LARC the day after it is requested and can keep it on hand for 30 days, at which time it must be returned.

The Illinois plan, which was introduced over the summer, would double doctor reimbursements for LARCs as well as vasectomies. The reimbursement rules in that state are also being revised so that women can ask for and receive the device in the same visit.

RH Reality Check spoke with Dr. Rebekah Gee, the medical director for Medicaid in Louisiana, which is in the process of making similar changes. She explained that as of October 20, Medicaid in Louisiana will cover the cost of both the device and the office visit required to insert them. Gee explained that providers were losing $200 every time they inserted the device, and that 30 percent of the devices ordered were going to waste.

“Now, we match what it costs for people to buy it so providers can stock it in their offices,” Gee said.

The other important change that Gee and her colleagues have been working on is reimbursement for immediate postpartum insertion of an IUD.

Ensuring that women have access to contraception after they give birth is vital to their health and the health of their future children. Gee explained that spacing births by at least 18 months to allow the woman’s body to recover can reduce the risk that future pregnancies will end in premature delivery or low birth weight babies.

Though delivery can be an ideal time to insert an IUD, many providers are not doing so, in part because they do not get reimbursed. Medicaid rules in many states essentially pay providers a lump sum for all services done during delivery, which means again that a provider would lose money if he/she inserted a LARC at that time.

Though it might seem like merely an inconvenience to tell women they would have to schedule an office visit at a later time, it is a much bigger problem than that—about 70 percent of women, according to Gee, who are eligible for Medicaid during pregnancy don’t qualify for it otherwise.

Gee said that her state is working on postpartum insertion of IUDs because too many women don’t receive the implant when they go in and out of the Medicaid system. In July, New York announced that it would institute a fee-for-service payment schedule during delivery in order to encourage postpartum IUD insertion. Other states that have taken this step include Colorado, Georgia, Iowa, New Mexico, and South Carolina.

Colorado’s experience in particular has shown than increasing access to LARCs is an effective and cost-effective move for states. It has been suggested that the CFPI program saved Colorado $42.5 million in large part by helping to reduce the teen pregnancy rate.

Gee says for her it’s not about the money: “The motivation is to provide women with safe, effective, no cost, contraception that works for them so that their lives and their birth outcomes will be better.”

In a debate Tuesday night, Colorado gubernatorial candidate Bob Beauprez said he’s opposed to using tax dollars for abortion. As a result, he said, he’d oppose using state funds for intrauterine devices (IUDs), which he believes cause abortions.

During a debate Tuesday against Colorado Gov. John Hickenlooper, Republican candidate Bob Beauprez said he has a “big problem” with public funding for intrauterine devices (IUDs) because they are “abortifacients.”

Hickenlooper asked Beauprez if he’d use public money for programs using contraception to reduce abortions and teen pregnancies:

Beauprez: I have no problem with people using contraception. I have a big problem, and here again is a debate, I have a big problem with publicly funding contraceptions that are actually abortifacients. Because our citizens have said over and over again that they don’t want taxpayer funding of abortions. So, the devil might be in the details, but I think it’s an extremely important distinction to draw in understanding to respect both the taxpayers’ will and the technology you referred to. Did I answer your question?

Hickenlooper: We’re talking about implants and IUDs. I don’t think they fit that–

Beauprez: [An] IUD is an abortifacient, John.

Beauprez, after the debate, stood behind the comment in an interview with Denver Post reporter John Frank, who quoted the candidate as saying, “Do you understand how IUDs work? The egg is fertilized and never allowed to impact. That’s why people who consider that life begins at conception believe (IUDs) are an abortifacient.”

Soon after the debate, abortion-rights organizations offered scientific findings that conflict with Beauprez’s stance on IUDs.

Pregnancy is defined by the medical establishment as beginning after a fertilized egg implants in the uterine wall. IUDs do not end such pregnancies.

Anti-choice groups charge that IUDs threaten or destroy fertilized eggs, which mark the starting point for their definition of “pregnancy” and serve as a foundation for so-called personhood laws discussed in state legislatures across the country.

Beauprez said during the debate that he supports “personhood,” but not the personhood amendments.

“Some believe that personhood refers to the belief that life begins at conception,” Beauprez told Hickenlooper after the governor asked him about his personhood stance. “I do believe that life begins at conception. I do believe that the personhood amendment [in Colorado], just like Archbishop Chaput believes, that the personhood amendment is very much the wrong solution.”

Intrauterine devices (IUDs) and implants are highly effective at preventing pregnancy and safe for women of all ages. Many think they are the ideal contraceptive method for adolescent girls. The American Academy of Pediatrics weighed in this week.

In new recommendations released Monday, the American Academy of Pediatrics (AAP) suggests intrauterine devices (IUDs) and contraceptive implants over other pregnancy prevention methods for sexually active teenage girls.

The policy statement, which was published in the October issue of Pediatrics and replaces a statement written in 2007, notes that pediatricians have an important role to play in reducing teen pregnancy and promoting contraceptive use.

The AAP has made recommendations on contraception to its members since 1980 and suggested that pediatricians become familiar with all contraceptive methods as well as the negative consequences of unintended teen pregnancy. This is the first time, however, that the organization has recommended that pediatricians consider long-acting reversible contraceptive methods (LARCs), including IUDs and implants, for their patients before other methods.

The recommendations note that pediatricians should encourage correct use of condoms for every sexual act, even for those adolescents using a LARC method. This is particularly important because neither the IUD nor the implant prevent the transmission of sexually transmitted infections, including HIV.

IUDs are small, T-shape devices that are inserted into the uterus by a physician. They prevent pregnancy primarily by interfering with the path of the sperm toward the egg.

Two of the IUDs on the market—Mirena and Skyla—release hormones similar to those in some birth control pills, which thickens the cervical mucus (creating a barrier to sperm) and may also prevent ovulation. The other type of IUD, called ParaGard, releases copper, which is thought to create an environment that is toxic to sperm.

ParaGard lasts for ten years, Mirena for five, and Skyla for three years, but any of them can be removed if a user wishes to become pregnant.

Contraceptive implants, sold under the brand name Nexplanon, are flexible plastic devices about the size of a matchstick that are inserted under the skin on a woman’s upper arm.

LARC methods are highly effective in large part because users can “set them and forget them.”

All contraceptive methods have two efficacy rates: the perfect use rate, which shows how well they can work if used consistently and correctly, and the typical use rate, which shows how well they do work for average couples during the first year.

The typical use rate for most contraceptive methods is lower than the perfect use rate because people make mistakes, from forgetting to refill a pill prescription to leaving the condom in the night table drawer. For LARC methods, however, the perfect use rate and the typical use rate are essentially the same; if the method is properly inserted by a physician, users can’t make mistakes.

IUDs have a failure rate of less than 1 percent. Implants have a failure rate of 0.05 percent, meaning that out of 100 couples who use these methods as their primary form of birth control, fewer than one couple will experience an unintended pregnancy in the first year of use.

Though IUDs were once thought to be safe only for older women or women who had already had children, research in the past decade has found that they are safe for women of all ages, including adolescents. Implants have also been found to be safe for women of all ages.

Given the safety and efficacy of these devices, many experts believe that they are the ideal birth control method for young women.

When choosing contraceptive methods, adolescents should be encouraged to consider LARC methods. Intrauterine devices and the contraceptive implant are the best reversible methods for preventing unintended pregnancy, rapid repeat pregnancy, and abortion in young women.

The AAP recommendations released this week are similar but focus more on the role the pediatrician should play.

Pediatricians should be able to educate adolescent patients about LARC methods including progestin implants and IUDs. Given the efficacy, safety, and ease of use, LARC methods should be considered first-line contraceptive choices for adolescents. Some pediatricians will choose to acquire the skills to provide these methods to adolescents. Those who do not should identify health care providers in their communities to whom patients can be referred.

]]>http://rhrealitycheck.org/article/2014/09/30/pediatric-academy-encourage-iuds-implants-sexually-active-teens/feed/0Advocates Call for Full Funding of Research on HIV and Contraceptionhttp://rhrealitycheck.org/article/2014/09/12/advocates-call-full-funding-research-hiv-contraception/?utm_source=rss&utm_medium=rss&utm_campaign=advocates-call-full-funding-research-hiv-contraception
http://rhrealitycheck.org/article/2014/09/12/advocates-call-full-funding-research-hiv-contraception/#commentsFri, 12 Sep 2014 15:33:55 +0000http://rhrealitycheck.org/?p=44969

For women in countries and communities with limited contraceptive choices and high rates of HIV, particularly in sub-Saharan Africa, a shortage of funding for the ECHO (Evidence for Contraceptive Options and HIV Outcomes) trial is an unacceptable development.

A clinical trial known as Evidence for Contraceptive Options and HIV Outcomes (ECHO)—originally designed to answer important questions about possible connections between risk of HIV infection and the use of non-barrier hormonal contraceptives—now hangs in the balance because of a funding shortfall. For women in countries and communities with limited contraceptive choices and high rates of HIV, particularly in sub-Saharan Africa, this is an unacceptable development.

Women make up more than half of all people living with HIV worldwide, and they continue to bear the burden of new infections. Incidence rates vary by age and country, but remain unacceptably high in the context of comprehensive, state of the art prevention services. (As one example, in the VOICE trial of women’s HIV prevention options, overall incidence was nearly 6 percent.) HIV incidence rates are particularly high in adolescent girls and young women, and globally HIV is the leading cause of death of women of reproductive age. The same women who are most at risk of HIV are also in need of a variety of reliable methods of contraception—a glaringly unmet need in sub-Saharan Africa, where fewer than 20 percent of women use a modern contraceptive method.

For those women in sub-Saharan Africa who do have access to contraception, the majority use a hormonal method (an injectable or the oral contraceptive pill). Of these women, 60 percent use a long-acting injectable such as Depo or, less frequently, NET-EN. This prevalence of these methods does not accurately reflect women’s preference since in many settings, Depo is one of a limited number of options for women—and often the only long-acting, discrete method (versus a daily contraceptive pill). Expanding the range of available choices is another key policy and advocacy priority, in sub-Saharan Africa and around the world, including in the United States.

Contraception not only allows women to determine when and how often they become pregnant, it also saves their lives. Risk of maternal morbidity and mortality—already unacceptably high in many parts of the world—rises even more in the context of unplanned pregnancies. Lack of access to effective contraception is a health and human rights issue that cannot be ignored.

At the same time, there are persistent questions about whether some contraceptive methods, particularly long-acting injectables like Depo, increase women’s risk of acquiring HIV. These questions arise from observational data. Some studies suggest that Depo does increase risk, while others do not. This is precisely the question that the ECHO trial is designed to answer.

According to the ECHO trial team, which has briefed civil society, it would cost roughly $60 million to conduct the ECHO trial—clearly a minimal investment when compared to the economic, social, and public health costs of HIV and AIDS, unplanned pregnancies, and maternal death and illness across sub-Saharan Africa. In fact, the ECHO trial seeks to answer a question raised 25 years ago: Do contraceptive methods, particularly hormonal contraceptive methods, increase women’s risk of HIV acquisition? The answer to this question is long overdue, and the lack of investment in such research reflects a lack of strategic and financial priority for a critical women’s health and rights question.

In discussing the trial, and other approaches to the current uncertainty, stakeholders have asked why the data are mixed, and whether it’s possible to gain clarity with the information available and/or with basic science studies. The main limitation of all of the existing data on both injectables and pills and potential HIV risk is that they come from observational trials that were not designed to answer the question directly. Confounding factors cannot be controlled for, and many trials rely on women’s self report about the method they were using. There simply aren’t enough women in sub-Saharan Africa using other strategies, like the implant or the intrauterine device, to gather even observational data. The existing information is, therefore, difficult to interpret, and leave unanswered critical questions that affect the lives and health of women who have urgent needs to both space or limit births and to protect themselves from HIV. The ECHO trial is designed to help answer these questions directly for Depo, the implant (Jadelle), and the copper intrauterine device—methods about which there are even less data. It has the potential to provide more definitive, actionable information thanbasic science research.

The ECHO trial is the type of research we have been waiting for, with great anticipation, since a 2012 World Health Organization (WHO) review of the existing data on hormonal contraceptives and HIV risk. In this review and in an update in July 2014, research is a clear priority. The document states, “WHO strongly supports the need for further research to identify definitive answers to these issues.”

ECHO was proposed to meet this identified need. It is a randomized clinical trial that would look at whether the three options—Depo, Jadelle, and the copper intrauterine device—affect HIV-negative women’s risk of acquiring HIV.

Advocates for HIV-positive women, HIV prevention advocates, and sexual and reproductive health advocates have been following this issue closely. We are united in the conviction that women should be fully informed in their contraceptive choices and that we should not have to choose between HIV prevention and safe and effective contraception. We are also united in the need to broaden the range of contraceptive options available and accessible to all women—in the context of complete data about their risks and benefits.

The concerns related to HIV risk have to be considered in the context of the health risks of pregnancy, particularly unintended pregnancies. Epidemiologists have calculated the new HIV acquisitions that might be attributable to Depo, in the event that it does increase risk, and the rates of maternal deaths and live births that would occur if Depo were to be withdrawn, without an immediately acceptable and accessible replacement. In both instances, the greatest impact on women is in east and southern Africa.

Given the level of maternal death and illness, not to mention other public health outcomes of unintended pregnanciesy, an increase in risk of HIV acquisition by users of Depo must be weighed against the risks associated with unintended pregnancies. But context does not mean conflict—and the urgent need for a mix of effective contraceptive methods does not outweigh the need for clarity about how methods affect women’s risk of HIV acquisition. No one wants to swap illness and death associated with HIV acquisition for pregnancy-related morbidity and mortality.

And, indeed, no one is advocating for Depo to be removed without providing affordable, accessible alternative contraceptives. But the status quo cannot stand because of the challenges ahead. Current WHO guidance on Depo states that “women at high risk of HIV infection should be informed that progestogen-only contraceptives may or may not increase their risk of HIV infection.”

Not only is the message confusing, but it is also incredibly challenging for those working in public health clinics to communicate. Without the ECHO trial, this confusing message will continue being given to women currently using or initiating Depo—if they receive any message at all. Even as other methods, such as the contraceptive implant, gain popularity in some regions, some women will still only have access to Depo and they will still be told “this might increase your risk; it might not”—unless a trial like ECHO takes place.

Unfortunately, the international funding community has not adequately committed to this research. Even before the current ECHO protocol was put on hold, it had already been scaled back once due to budget concerns. This trial design should be driven by scientific questions and women’s needs, not funding.

We call on the donors to ensure the trial is fully funded without additional budget cuts or delays. We call on funders who have stepped up to date, including the Bill & Melinda Gates Foundation, USAID, the South African government, the South African Medical Research Council, the Wellcome Trust, and the UK Medical Research Council to maintain and/or expand on existing funding commitments. We challenge the U.S. National Institutes of Health and the European & Developing Countries Clinical Trial Partnership to confirm their partnership with and support for this research. And we urge these funders to work together to undertake vigorous advocacy that bridges the HIV and contraceptive research agendas. Each of these organizations have spoken about the need to promote women’s health and now they must invest in doing so. The amount of funding needed is minimal compared to investments in many other HIV prevention trials. These price tags reflect vastly different research questions and infrastructure requirements—however the point remains that this is a relatively small investment to answer a question of enormous importance.

Some funders, scientists, and advocates have raised issues about whether the trial is necessary or feasible. One argument is that the world can go ahead and increase method mix, moving away from Depo and toward other methods, without the ECHO trial. This would mean expanding access to other hormonal methods without any additional information about their relationship to HIV. The question about whether the trial is feasible—whether women will enroll, accept randomization, remain on methods, and so on—is valid, and can only be answered by attempting the trial. ECHO investigators say the research would be implemented with monitoring that would gauge feasibility in real time—allowing the trial to be stopped or altered if it was necessary.

Although concerns about the trial are fair, a $60 million investment in this set of questions is one of the best research investments that could be made in reproductive health and rights in the context of women and HIV today. As women in all our diversity, this advocacy—and the clarity it can engender about our contraceptive choices—is long overdue. Women at risk of HIV deserve to know whether their choice of contraception affects their chances of acquiring HIV. Now is no time to turn back.

If ever there was a dearth of really bad ideas, especially bad ideas masquerading as giving women “control” over their lives (dare I say, “empowering” them—a term on which I tend to choke), this one will fill the hole for many years.

Referred to in the MIT Technology Review as a candidate for the elusive “perfect contraceptive,” this new wireless device will, once implanted under the skin, deliver via remote on/off control measured doses of levonorgestrel (an ingredient of birth control pills that are already on the market) daily for up to 16 years in the woman with the chip.

It’s hard to know where to start in enumerating all the imperfections of this device. But a couple of the problems include how it not only removes control from women, but places it in who-knows-who’s hands, since everything that can go wrong with remote-controlled devices could happen with this device. There really is no foolproof way to ensure that only “registered” people will have access to control the electric current needed to open the seal on the device to release the daily doses. Nor can there be guarantees that hackers won’t be able to access either the device itself or some interconnected computerized information or devices. And what about the potential mechanical failure of the device in the short or long term? What risks might there be from 16 years of use?

The device, which can be turned on and off without a doctor’s assistance, eliminates the need for a woman to visit a clinic to obtain contraceptives. While some have been touting this as a positive thing, saying it puts the power in the users hands, it also means there will be no visits to ensure the safety of the drug in the woman’s system, no opportunity to ensure she is aware of the need for condoms to protect against sexually transmitted infections, and no way to stop the drug delivery on her own. In other words, just as with earlier implanted forms of contraception (for example, Norplant and more recent implants referred to as LARCs, or long-acting reversible contraceptives),a health professional must remove the device; the patient herself cannot. And though small, there will be visible scars where the device is inserted.

We’ve already been down this hazardous route with earlier versions of long-lasting contraceptive implants—and their often coerced use, especially among individuals thought not able to manage their bodies themselves (for example, teens and marginalized women). Despite beliefs that technology is the answer to women’s health needs, it is too often the case that technologies create even more needs from the damage they can do, especially when drugs are involved (such as diethylstilbestrol, a synthetic estrogen, which caused serious damage to children whose mothers had taken this drug while pregnant, or hormone treatment of women experiencing minimal symptoms linked to menopause, which has been associated with an increased risk for the later development of breast cancer and heart disease).

Yes, women, especially those in the global south or living in remote regions worldwide, do need safe, effective ways to ensure that they truly have a choice in their decision to have or not have children and to raise them as they want. With thanks to Loretta Ross for giving us a term for this, we need reproductive justice.

But it seems to me that this remote-controlled implant may be more likely to deliver injustice along with the hormones it releases, to the extent that it is likely to be tested on and applied to women for whom authentic informed choices may be limited because of their age or the circumstances of their lives.

The Gates Foundation and its partners might be better off investing in developing abortion and maternity services that are safe and accessible in all ways and access to health workers (not just physicians) for women.

]]>http://rhrealitycheck.org/article/2014/07/16/im-skeptical-remote-controlled-birth-control-chip/feed/4We May Be a Few Years Away From a Remote-Controlled Birth Control Methodhttp://rhrealitycheck.org/article/2014/07/11/may-years-away-remote-controlled-birth-control-method/?utm_source=rss&utm_medium=rss&utm_campaign=may-years-away-remote-controlled-birth-control-method
http://rhrealitycheck.org/article/2014/07/11/may-years-away-remote-controlled-birth-control-method/#commentsFri, 11 Jul 2014 15:18:40 +0000http://rhrealitycheck.org/?p=42131

A new remote-controlled contraceptive implant is in development and could be on the market by 2018. It would last up to 16 years, and women could turn off the device themselves without a trip to a health-care provider.

Birth control and technology may be meshing in new ways soon with the possible release of an implantable microchip that can release hormones to prevent pregnancy for up to 16 years. The device would be able to be turned off using a remote control if a woman decides she wants to become pregnant, and turned back on when she wants to prevent pregnancy again.

The Bill and Melinda Gates Foundation has announced that it is backing MicroCHIPS, a Massachusetts start-up that has developed this new technology, to help bring the product through the testing process. The new method could be available as early as 2018.

The chip contains tiny reservoirs of the hormone levonorgestrel, a form of progestin that is already used in many hormonal birth control methods. Once the device is implanted by a health-care provider into a woman’s arm, buttocks, or abdomen and turned on, a small electric charge will go through it each day melting the ultra-thin seal around the medication and delivering a 30-microgram dose of hormone into the body. The chip will do this every day for 16 years unless the woman decides to turn it off, which she would be able to do herself, without a trip to her health-care provider.

One concern that’s arisen in the initial reactions to this technology is that someone could theoretically turn the chip on or off without the woman’s knowledge. But Robert Farra, MicroCHIPS president and COO, told BBC News that this is less likely than it sounds. “Communication with the implant has to occur at skin contact level distance,” he said. “Someone across the room cannot reprogram your implant. Then we have secure encryption. That prevents someone from trying to interpret or intervene between the communications.”

The company is working on additional encryption to make sure no information could be gathered from the microchip.

MicroCHIPS has already tested many aspects of the technology to see if it could deliver an osteoporosis medication that has traditionally been given to patients through injections. Initial studies in women found that the microchip was able to consistently administer an accurate dose of the medication. Moreover, the chip itself did not cause any adverse side effects.

According to MIT Technology Review, the idea to turn the chip into a birth control delivery system came from Bill Gates himself, who visited the lab two years ago and questioned whether the technology could be used as a long-acting reversible contraception (LARC) method.

Currently there are two LARC methods on the market—the intrauterine device (IUD) and the contraceptive implant. LARC methods have the highest efficacy rates against unintended pregnancy, in large part because they take user error out of the equation. Once the method is inserted, it works without any effort on the part of the user for a period of three to ten years. If a woman decides she wants to get pregnant, however, she needs to go to a health-care provider to have the device removed, and if she decides to go back on the method after pregnancy, she would need a new device. Both IUDs and implants have high up-front costs when not covered in part or full by insurance, compared to other methods.

If the chip comes to market, it could be a game changer in parts of the world where access to health-care providers and contraceptive methods is very limited. The chip technology is also being looked at to deliver medicines to treat diseases such as multiple sclerosis and diabetes.